NORMAL AIRWAY
Obstructive Sleep Apnea
In Children
Obstructive sleep apnea (OSA) is a problem that
affects your child’s breathing during sleep. An
obstruction is a blockage of airflow into the lungs.
Apnea (Ap-nee-uh) means a pause in breathing
for at least 10 seconds. A child (or adult) with
obstructive sleep apnea has times during sleep
when air cannot flow normally into the lungs.
These pauses in airflow occur off and on during sleep. A
child who has frequent apnea spells has a poor quality
of sleep. With time, untreated sleep apnea can result in
serious health problems. About 10 percent of children
snore regularly, but only about 1 to 3 percent of children
who snore have sleep apnea. (For information on sleep
apnea in adults see the ATS Patient Information Series
“What is Obstructive Sleep Apnea in Adults”).
What causes obstructive sleep apnea in children?
Risk factors are things that make it likely that your child
might have sleep apnea. A child can have more than one
risk factor for sleep apnea. The more risk factors your
child has, the greater their chance of having sleep apnea.
Risk factors for OSA in children include:
■■ Large Tonsils and/or Adenoids: Large tonsils and/
or adenoids can block the airway. This is the most
common risk factor for OSA in children. Tonsils and
adenoids are lymph nodes. Tonsils are found on each
side in the back of your throat. The adenoids are high
in the throat, behind the nose, and are not easily seen
through the mouth. Both of these can grow into large
amounts of tissue, causing blockage in the back of the
throat. Medical conditions such as allergies, acid reflux,
sickle cell disease, or frequent infection can cause the
tonsils or adenoids to grow larger. Many children have
large tonsils or adenoids, but not all will have sleep
apnea.
■■ Obesity: Children who are very overweight are more
likely to have sleep apnea.
■■ Problems with muscle tone: Children can have trouble
breathing during sleep because the throat muscles relax
and block the airway. This can happen in any child, but
especially in conditions such as muscular dystrophy
and cerebral palsy.
■■ Genetic syndromes: Children with genetic diseases such
as Down syndrome and Prader-Willi syndrome can
have OSA.
■■ Abnormal Face or Throat: Children who have an
abnormal shape to their face or throat can be at risk for
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NORMAL AIRWAY
OBSTRUCTED AIRWAY
OBSTRUCTED AIRWAY
sleep apnea. For example, a small chin or throat, a large
tongue, or a cleft palate (hole in the roof of the mouth)
can result in OSA.
Problems with Breathing Control: Some problems in the
brain can affect a child’s breathing during sleep.
Family history: Sleep apnea can run in families, so a
child’s risk for OSA may be increased if another family
member has sleep apnea.
How do I know if my child has sleep apnea?
There are many clues that your child may have sleep
apnea. During sleep, your child can have:
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Snoring that may or may not be loud. Snoring can
come and go through the night, but is heard every
night.
Gasping or choking sounds or noisy breathing that may
be worse when your child is on his or her back.
Breathing pauses. It can look like your child has
stopped breathing for a short time, and then breathing
starts again, often with a “snort”.
Problems breathing through their nose, so they need to
keep their mouth open. This may also occur during the
daytime.
Restless tossing and turning or unusual sleep position.
Frequent awakenings from sleep.
Bedwetting, particularly if your child has not usually
been wetting the bed at night.
Poor sleep at night can cause difficulties during the day.
During the day, children with sleep apnea can have:
■■ Attention problems or poor performance in school.
■■ Hyperactivity and other behavior problems.
■■ Personality changes such as being moody, cranky or
irritable.
■■ Sleepiness—falling asleep in school or napping at
unusual times.
■■ Fatigue or extreme tiredness.
■■ Headaches, especially in the morning.
■■ Speaking with a nasal sounding voice.
Am J Respir Crit Care Med Vol. 180, P5-P6, 2009 • Reviewed and revised August 2012.www.thoracic.org
ATS Patient Education Series © 2014 American Thoracic Society
What problems can occur with untreated
sleep apnea?
Sleep apnea can affect your child’s quality of life.
Untreated, sleep apnea can cause serious problems sooner
or later. Some children can have their growth affected.
Sleep apnea can also worsen other medical conditions.
Over time, sleep apnea can cause high blood pressure
(hypertension) and lead to a higher risk of heart disease
and death.
How do I find out if my child has obstructive
sleep apnea?
To see if your child may have sleep apnea, begin by
having your child’s health care provider do a history and
physical to look for signs and symptoms of OSA. You may
want to make a video recording of your child sleeping
to show your health care provider. Sleep apnea is usually
diagnosed by doing a polysomnogram (a study done in
a sleep laboratory at night). During this sleep study, your
child’s breathing effort, oxygen level, heart rate, electrical
activity of the brain, and sleep state are recorded. (For
more information, see the ATS Patient Information Series:
“Sleep Studies”). Other tests may be done depending on
your child’s condition and risk factors.
How is obstructive sleep apnea treated in
children?
Many types of treatments can be done to control your
child’s OSA. Many times, several have to be tried to find
the one that works best for your child. Treatments might
include:
1.Weight loss: If your child is overweight, talk to their
health care provider about a safe, effective weight
control program.
2.Sleep position: Sleep apnea is usually worse when lying
on one’s back. Have your child sleep on his or her side.
A pillow behind your child’s back may keep them from
rolling onto their back. Using pillows to help your child
sleep sitting more upright might also help.
3.Treatment of nasal allergy: Allergies can cause swelling
and congestion in the nose which can cause or make
the OSA worse. Allergies can benefit from medical
treatment. Talk to your child’s health care provider if
you think your child has allergies causing snoring.
If these treatments don’t help, surgery or a sleep device
may be recommended.
What type of surgery can be done for
sleep apnea?
small hole is made in the windpipe and a tube is inserted
into the opening. (For more information, see ATS Patient
Information Series: “Use of a Tracheostomy with a Child”).
There are other types of surgery that have been tried in the
throat or tongue, but these are not usually as successful as
the sleep device called nasal CPAP.
What is nasal CPAP?
Nasal continuous positive airway pressure (CPAP) is the
most common and effective treatment for sleep apnea
that cannot be corrected by surgery. The CPAP device is a
compressor that pushes air into a mask that is worn snugly
over the nose during sleep. The pressure pushes the air
through the nose and throat to prevent the throat from
collapsing during sleep. The goal is that your child will
have little or no snoring when wearing CPAP. A similar
type of device is called biPAP (short for bilevel positive
airway pressure support). This type of device varies the
pressure with high pressure when breathing in and a lower
pressure when breathing out. The amount of pressure that
is given can be tested during a sleep study to see that it
controls your child’s apnea.
Authors: Marianna Sockrider MD, DrPH;
Carol L. Rosen MD, Harold J. Farber MD, James A. Rowley, MD,
Suzanne C Lareau RN, MS
For more information contact the following websites:
National Sleep Foundation
www.sleepfoundation.org
American Family Physician
www.aafp.org/afp/20040301/1159ph.html
American Sleep Apnea Association
www.sleepapnea.org/resources/pubs/child.html
Action Steps
Talk to your child’s health care provider
4 If you notice symptoms of OSA in your child.
4 To see if your child should have a sleep study.
4 To find out what treatment is best for your child.
4 To safely help your child reach a healthy weight.
Health Care Provider’s Office Telephone:
Many children can benefit from surgery to remove
the tonsils and adenoids (called adenotonsillectomy).
Symptoms of OSA should improve after surgery. Some
children will need to have another sleep study 2-3 months
after surgery. A tracheotomy is done in children with
severe, life-threatening sleep apnea. In this procedure, a
The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing
in this series is for educational purposes only and should not be used as a substitute for the medical advice one one’s personal health care
provider. For further information about this series, contact J.Corn at [email protected].
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